Diagnostic value of cerebral vasospasm by transcranial doppler ultrasound in Vietnamese patients with subarachnoid hemorrhage.

OBJECTIVE: Although the application of transcranial Doppler (TCD) ultrasonography in clinical diagnosis of cerebral vasospasm is popular in clinical practice in Vietnam, available evidence of the predictive value of vasospasm on TCD in the literature was mostly reported from large institutions in developed countries. Hence, this study was conducted to evaluate the value of TCD ultrasonography in the diagnosis of vasospasm in patients with subarachnoid hemorrhage (SAH) in Vietnam. PATIENTS AND METHODS: This is a prospective observational study of all aneurysmal SAH patients consecutively admitted to a single center between 2008 and December 2011. TCD and 64-slice computed tomographic angiography (CTA) were used to cerebral vasospasm in SAH patients. RESULTS: 316 patients were analyzed (mean age = 52.97±12.27 years, 52.2% males). There were statistically significant difference rates of the cerebral vasospasm by Hunt and Hess Classification and Fisher classification (p <0.01). The proportion of the patients with cerebral vasospasm who were diagnosed exactly by TCD was 95.2%, while the proportion of the patients without cerebral vasospasm diagnosed exactly was 91.5%. TCD predictive diagnostic value was the highest, with the sensitivity of 0.95 (95% CI: 0.91-0.98), specificity of 0.91 (95% CI: 0.85-0.96), positive predictive value of 0.94 (5% CI: 0.90-0.97) and negative predictive value of 0.93 (95 CI: 0.87-0.97). Hemiplegia was the clinical symptom with the highest diagnostic value with the sensitivity of 0.34 (95% CI: 0.27-0.41), specificity of 0.92 (95% CI: 0.86-0.96), positive predictive value of 0.86 (95% CI: 0.76-0.93) and negative predictive value of 0.49 (95% CI: 0.41-0.54). CONCLUSIONS: Evidence of vasospasm diagnosis on TCD ultrasonography was found with high accuracy. Current study enables to suggest the wide application of TCD in Vietnam health facilities from central to grassroots levels instead of the CTA use.

Physical activity during pregnancy is associated with a lower prevalence of gestational diabetes mellitus in Vietnam.

AIMS: To assess the association between physical activity (PA) during pregnancy and the prevalence of gestational diabetes mellitus (GDM) accounting for sitting time. METHODS: The study used data from a cohort study of 2030 pregnant women in Vietnam. Women were recruited from six hospitals in Ha Noi, Hai Phong, and Ho Chi Minh City. Baseline measurements including PA and GDM were taken at 24-28 weeks of gestation. PA was assessed during the past 3 months before the interview using the interviewer-administered Pregnancy Physical Activity Questionnaire. GDM was diagnosed at 24-28 weeks of gestation using the 2013 World Health Organization criteria. RESULTS: 1987 out of 2030 pregnant women were included in the final analysis, of which 432 had GDM (21.7%). Women undertaking the highest level (upper tertile) of PA during pregnancy appeared to have a lower risk of GDM [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.53-0.94, Ptrend 0.017] when compared to those at the lowest tertile of PA. Similarly, women with increased levels of moderate-intensive activity and household/caregiving activity during pregnancy were associated with reduced risks of GDM (OR 0.66, 95% CI 0.50-0.86, Ptrend 0.002 and OR 0.72, 95% CI 0.55-0.95, Ptrend 0.020, respectively). These apparent inverse associations were not attenuated by their sitting time. There were no significant associations between sitting time, light-intensity activity, vigorous-intensity activity, occupation, sports/exercise, commuting, or meeting exercise guidelines and GDM risk. CONCLUSIONS: High levels of PA, particularly moderate-intensity and household/caregiving activities during pregnancy were associated with a lower prevalence of GDM independent of sitting time.

Evaluation of the integrated clinic model for HIV/AIDS services in Ho Chi Minh City, Viet Nam, 2013-2014.

Setting: Ho Chi Minh City (HCMC), Viet Nam. Objective: To evaluate a new integrated service model for human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) care. Design: In HCMC, co-located services, including voluntary HIV counseling and testing (VCT), HIV treatment at out-patient clinics (OPC), and methadone maintenance therapy (MMT) for persons who inject drugs, have operated under different administrative structures. In the context of decreasing international financial support, integration of these services into one administrative structure with reduced staff occurred in seven districts in HCMC between October 2013 and June 2014. We used a pre-post study design to compare service-related outcomes from routinely collected data at health facilities 6 months before and 6 months after integration. Results: The proportion of HIV-infected persons linked from VCT to OPCs was unchanged or increased following integration. A higher percentage of patients eligible for antiretroviral therapy (ART) were started on ART. The proportion of ART patients lost to follow-up remained unchanged. The proportions of MMT patients who tested positive for heroin or other substances decreased or were unchanged. Conclusions: VCT, OPC and MMT service delivery quality remained the same or improved during the 6 months following the integration. Expansion of the integrated model should be considered for HIV-related services.

Contexte : Ho Chi Minh City (HCMC), Viet Nam.Objective : Evaluer un nouveau modèle intégré de services pour la prise en charge du virus de l'immunodéficience humaine (VIH) et syndrome de l'immunodéficience acquise (SIDA).Schéma : A HCMC, des services installés au même endroit, incluant le test et conseil volontaire du VIH (VCT), le traitement du VIH en consultation externe (OPC) et le traitement de substitution par méthadone (MMT) pour les utilisateurs de drogues injectables, ont fonctionné sous différentes structures administratives. Dans le cadre de la réduction du soutien financier international, l'intégration de ces services dans une seule structure administrative avec un personnel réduit a eu lieu dans sept districts de HCMC entre octobre 2013 et juin 2014. Nous avons utilisé un schéma d'étude avant-après afin de comparer les résultats liés à ces services à partir de données recueillies en routine dans des structures de santé 6 mois avant et 6 mois après l'intégration.Résultats : La proportion de patients VIH positifs envoyés du VCT vers les OPC n'a pas été modifiée ou a augmenté après l'intégration. Un pourcentage plus élevé de patients éligibles à les traitements antirétroviraux ont mis en route ce traitement. La proportion de patients sous ART perdus de vue est restée sans changement. Les proportions de patients MMT, chez qui la recherche d'héroïne ou d'autres substances a été positive, ont diminué ou sont restées inchangées.Conclusions: La qualité des services de VCT, OPC et MMT est restée la même ou s'est améliorée pendant les 6 mois suivant l'intégration. L'expansion du modèle intégré devrait être envisagée pour les services relatifs au VIH.

Marco de referencia: La Ciudad de Ho Chi Min.Objetivo: Evaluar un nuevo modelo de servicios integrados de atención de la infección por el virus de la inmunodeficiencia humana (VIH) y síndrome de inmunodeficiencia adquirida (SIDA).Método: En la Ciudad de Ho Chi Min, los servicios simultáneos de pruebas voluntarias y orientación sobre el VIH (VCT), de tratamiento en consulta externa de la infección por el VIH (OPC) y de tratamiento de mantenimiento con metadona a los consumidores de drogas inyectables (MMT) han funcionado en estructuras administrativas diferentes. En el contexto de una disminución del apoyo económico internacional, de octubre del 2013 a junio del 2014, se integraron estos servicios en una estructura administrativa única en siete distritos de la ciudad. En un estudio con análisis anterior y posterior a la intervención se compararon los resultados de estos servicios, a partir de los datos corrientes recogidos en los establecimientos de salud 6 meses antes de la integración y 6 meses después de la misma.Resultados: Después de la integración, la proporción de personas infectadas por el VIH vinculadas por los centros de VCT a los OPC permaneció invariable o aumentó; un porcentaje más alto de pacientes aptos para recibir el tratamiento antirretrovírico (TAR) lo iniciaron; la proporción de los pacientes en TAR que se perdieron durante el seguimiento permaneció estable; y las proporciones de los pacientes que recibían MMT que obtuvieron un resultado positivo para la heroína u otras sustancias disminuyeron o no se modificaron.Conclusión: Seis meses después de su integración, la calidad de la prestación de servicios de VCT, OPC y MMT permaneció estable o se mejoró. Se recomienda considerar la posibilidad de ampliar la escala de aplicación del modelo integrado de servicios relacionados con el VIH.

Sequence specificity of bacteriophage 434 repressor-operator complexation.

The binding affinity of the bacteriophage 434 repressor for its DNA operator depends strongly on the nature of two central base-pairs that are not in contact with the dimeric protein. In order to investigate the origin of this sequence specificity, we carried out molecular modelling of five model operators with central TA, AT, CG, GC and IC sequences. The five oligomers were studied both before and after complexation with the N-terminal binding domain of the 434 repressor. The relative importance of nucleic acid flexibility on operator-repressor binding was studied via a low frequency normal mode analysis using an internal coordinate method that we developed recently. The results suggest a higher twisting flexibility for TA and AT central steps than for CG, GC or IC steps, but the differences appear to be too small to account for the strength of repressor binding. An energetic analysis of the model operator-repressor complexes reveals rather that the preference for A.T and T.A base-pairs is electrostatic in origin and is linked to the presence of cationic Arg43 side-chains of repressor. This conclusion is supported by comparison with an R43A mutant and correlates with the sequence dependence of the electrostatic potential in the central minor groove of the operators.

Naturally-acquired dengue virus infections do not reduce short-term survival of infected Aedes aegypti from Ho Chi Minh City, Vietnam.

Transmission of dengue virus (DENV) from mosquito to human is dependent upon the survival of the mosquito beyond the virus extrinsic incubation period. Previous studies report conflicting results of the effects of DENV on Aedes aegypti survival. Here, we describe the effect of DENV on the short-term survival (up to 12 d) of 4,321 Ae. aegypti mosquitoes blood-fed on 150 NS1-positive dengue patients hospitalized in the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Mosquito survival was not different between cohorts that fed upon blood from which 0% of mosquitoes became DENV infected (N = 88 feeds), or 100% became infected (N = 116 feeds). Subgroup analysis also did not reveal serotype-dependent differences in survival, nor a relationship between survival and human plasma viremia levels. These results suggest that DENV infection adds minimal cost to Ae. aegypti, an important finding when parameterizing the vector competence of this mosquito.

Elevated antifilarial IgG4 antibody levels in microfilaremic and microfilaridermic Gabonese adults and children.

Immunologic analyses of sera from 47 selected individuals living in a mixed filariasis transmission zone in Gabon were carried out. Onchocerca volvulus, Loa loa, Mansonella streptocerca, and M. perstans are transmitted in this region. Based on parasitologic findings and age, the 47 individuals were stratified into four groups: microfilaria negative (Mf-) children (3-15 years old), Mf- adults (> 15 years old), microfilaria positive (Mf+) children and Mf+ adults. For descriptive purposes, the term microfilaria positive refers to individuals with skin and blood microfilariae. Antifilarial antibody titers were determined using an enzyme-linked immunosorbent assay with Dipetalonema viteae antigens. In general, children had higher titers of IgG antibodies than adults. For the IgG1, IgG2, and IgG3 subclass responses, both age and microfilarial status appeared to be important variables since Mf- children consistently had the highest titers whereas Mf- adults had the lowest titers. For the IgG4 antifilarial response, only the microfilarial status was an important variable. All Mf+ individuals had significantly higher levels of IgG4 antibody than Mf- individuals. Pooled sera of Mf- and Mf+ individuals reacted with similar O. volvulus antigens on Western blots. Control sera of individuals who did not reside in the study area, but who had single infections with L. loa or M. perstans, did not react with any O. volvulus antigens.

Short- and long-term action of multiple doses of ivermectin on loiasis microfilaremia.

One hundred nine Gabonese patients infected with Loa loa microfilariae were treated with ivermectin (200 microg/kg of body weight) at the Parasitology, Mycology and Tropical Medicine Department (Faculte de Medecine et des Sciences de la Sante, Libreville, Gabon). Each was given one dose per month for six consecutive months. The peripheral blood microfilaria (mf) count before and after each dose showed an average decrease in the microfilaremia of 87.3% (short-term-single dose). An annual single-dose mass treatment with 200 microg/kg of ivermectin was sufficient to control the parasite in populations with low (< 400/ml) L. loa mf counts. One month after the sixth dose (short-term-multiple doses), the average microfilaremia rate had decreased by 99.2% compared with the initial infection (35 patients). Samples were taken from 28 patients one month after the first dose and one month after the sixth dose. The average mf count decreased by 96.4% after the first dose and by 99.6% after the sixth dose (average residual mf counts = 13.7 and 1.5 mf/ml, respectively). The mf count after the sixth dose was only 11.2% of the count after the first dose. The low mf count persisted for more than six months after the sixth treatment (long-term-multiple doses). Thus, mass treatment with multiple doses is more appropriate for areas where the blood mf count is very high. These results show that the number of the annual treatments used in mass chemotherapy with ivermectin can be adapted to each population to provide efficient protection.

Light microscopic changes in Plasmodium falciparum from Gabonese children treated with artemether.

The changes in Plasmodium falciparum in four Gabonese children suffering from severe malaria and treated with pure artemether were observed in thin blood smears fixed and stained with Giemsa and examined by light microscopy. Peripheral blood samples were taken every 8 hr up to 72 hr from three children and every 3 hr up to 9 hr from the other child. The morphologic changes involved all development stages (trophozoites, schizonts, and gametocytes); they were first seen 3 hr after the start of treatment and all parasites were abnormal after 24 hr. After two days of treatment, all infected erythrocytes disappeared except for a few with necrotic trophozoites. The morphologic changes were similar to the ultrastructural changes previously described in vivo and in vitro in experimental models. They confirm the rapid effect of artemisinin derivatives on parasite clearance and clinical recovery, particularly in cases of cerebral malaria.

Reduced Loa loa microfilaria count ten to twelve months after a single dose of ivermectin.

The action of a single dose of ivermectin (200 micrograms/kg) on 71 Gabonese patients with Loa loa microfilariae in the peripheral blood, and living in areas highly endemic for loiasis, has been evaluated. Ten to 12 months after treatment, 43 patients (63%) had no circulating microfilaria and the geometric mean peripheral blood microfilaria count had decreased by 88.6% (P < 0.02). Thus, a single annual dose of ivermectin can markedly reduce loiasis transmission.

[Cryopreservation of isolates of Toxoplasma gondii in cell culture]. / Cryopréservation d'isolats de Toxoplasma gondii en culture cellulaire.

For a better preservation and identification of Toxoplasma gondii isolates, we propose a new method of freezing of toxoplasma growth in THP-1 cell culture. A cystogenic strain isolated from foetal blood has been grown in these cells and frozen in liquid nitrogen. After thawing, toxoplasma recover the same growth rate and morphology in vitro and the same capacity to form brain cysts into mice compared to the initial strains. The freezing of the cell suspension provides a simple and appropriate method for preservation of Toxoplasma gondii within "bank" isolates.

[First clinical and serological description of leptospirosis in Gabon]. / Première description clinique et sérologique de la leptospirose au Gabon.

We report the first case of leptospirosis describe in Gabon. Several environmental factors could favour the transmission of the disease in that country.

[Variation of cholostase enzymes (5'-nucleotidase and alkaline phosphatase) during a specific treatment for malaria in the Gabonese child]. / Variation des enzymes de la cholostase (5'nucléotidase et phosphatase alcaline) au cours d'une thérapeutique curative spécifique du paludisme infection et maladie chez l'enfant Gabonais.

Biological variations of 5'nucleotidase (5'NU) and alkaline phosphatase (AP) in 102 Gabonese children with malaria features (MF) and malaria infection (MI) receiving treatment are reported. [formula: see text] During the therapeutic assay, 5'NU rate decreases faster than AP'S; Fourteen days after the beginning of treatment, difference between AP MF and AP M1 is still significant. Enzymes decrease is an indication of the malaria drugs tolerance (MSP (*)).

[Toxoplasmosis in Gabon. Results of a seroepidemiological investigation]. / Toxoplasmose au Gabon. Résultats d'une enquête séro-épidémiologique.

A toxoplasmosis sero-epidemiological inquiry was effected with 2,324 sera collected from Libreville, Lébamba, Makokou, Lastourville and Woleu-Ntem. All the sera were first screened through Pastorex toxo (Diagnostics Pasteur). Those with more 8 IU/ml and 267 sera with less 8 IU/ml were then assayed by ISAGA (bioMerieux) for IgM. The results of ISAGA must be interpreted with carefulness for natural agglutinins are frequent in this population. The acquisition of immunity is precoce and more of 60% have a serology positive from ten years old. There was no difference between sex.

[Results of a systematic search for Plasmodium in internal medicine in Gabon]. / Résultats d'une recherche systématique d'hématozoaires en médecine interne au Gabon.

Among 158 adults hospitalized at the University Hospital of Libreville who did not receive any treatment against malaria before blood screening, 20 were carriers of malaria parasites. Plasmodium falciparum was seen in 19 cases with a parasitic density lower than 1,000 trophozoits/mm3 of blood in 18 cases. The most important prevalence was observed into the group of older people. In most cases symptoms related to malaria did not occur during the hospitalization. We conclude that, in such patients, a parasitic density lower than 1,000 trophozoits/mm3 is not sufficient to assess the diagnosis of malaria and does not deserve systematic treatment.

[Role of cryptosporidiosis in infants in Gabon. Results of two prospective studies]. / Place de la cryptosporidiose chez l'enfant au Gabon. Résultats de deux enquetes prospectives.

Two epidemiological surveys of cryptosporidiosis in urban and suburban areas of Libreville, Gabon, Equatorial Africa, were conducted in children. On 450 fecal samples on the first study, Cryptosporidium sp. has been seen about 3.11%. For the second survey, on 296 children, aged between 0 and 2 years, with acute diarrhoea, the rate of infestation was 24%. The maxima was observed for infants aged between 6-18 months, in case of malnutrition and during wet seasons.

[Malaria, pregnancy and prophylaxis]. / Paludisme, grossesse et prophylaxie.

We present two case histories. The first is a case of congenital malaria in a newborn whose Laotian mother immigrated into France 2 years ago. The other is a case of very severe malaria with fetal death in a 28 year old woman who was 8 months pregnant and who had come back to France from Gabon where she had lived for 2 years. The authors wish to draw attention to malaria brought into the country and how serious it can be, and suggest prophylactic measures to be applied for pregnant women and their newborn babies.

[Antiparasitic treatments in pregnant women and in children in 2003]. / Traitements antiparasitaires chez la femme enceinte et chez l'enfant en 2003.

Like antibacterial agents, antiparasite drugs for pregnant women and children must be chosen in function of the stage of pregnancy, age of the child, and expected benefit-risk ratio. While no agent is totally safe, there are few absolute contraindications. Most zones of serious endemic parasite disease are located in developing countries where parasite, bacterial, or viral conditions combined with poor nutrition treatment make it necessary to treat disease in a complex pathogenic environment that weakens pregnant women and children with multiple parasite infections. In both temperate and tropical zones, there have been few real therapeutic advances involving release of new products on the market or development of new indications for existing products. Constant appearance and extension of hematozoa resistance to conventional and even more recent antimalarial agents have prompted research to find new active drugs and long-lasting treatment combinations. Real therapeutic breakthroughs have resulted from the need to develop safe drugs without substantial side-effects for single-dose use in control programs against endemic parasite diseases in mass populations including pregnant women and young children in tropical zones. There are several notable examples in the field of major verminous diseases. Ivermectin is a versatile drug that can be used against filariasis as well as for management of intestinal worms or ectoparasitosis in temperate and tropical countries. Praziquantel is an important advance in platyhelminthiasis, especially bilharziais. Triclabendazole, the latest addition to the benzimidazole family, has shown promise as a substitute for bithionol, that is difficult to procure and not recommended in pregnant women, for treatment distomiasis occurring in pregnant women and children. Other examples include albendazole against giardiasis, nitazoxamide against cryptosporidiosis, artemisinine against bilharziasis, and paramomycine, not recommended in pregnant women, against leishmaniasis.

[Schistosoma mekongi bilharziasis along the Mekong River and its affluents, the Mun and Tonle Sap Rivers. General review]. / La bilharziose à Schistosoma mekongi le long du Mékong et de ses affluents Mun et Tonle Sap. Revue générale.

First cases of Schistosomiasis in the South East Asian were described 30 years ago but the existence of a particular species in this area: Schistosoma mekongi has been discussed for a long time. During the last few years, emigration of Laotian and Cambodian people allowed a better knowledge of this affection. Through recent literature the authors make a restatement of the epidemiology, biology and treatment of this disease.

[Serological study of toxoplasmosis and echinococcosis in cattle breeders and abattoir personnel in Benin]. / Etude sérologique de la toxoplasmose et de l'hydatidose chez les éleveurs de bovins et le personnel des abattoirs au Bénin.

In Benin, a serological study of toxoplasmosis and hydatid disease has been effected among bovine stock-breeders and the staff of the slaughter-houses in comparison with a sample of blood donors. Our results reveal the highest rate of toxoplasmosis infection (87%) among the staff of the slaughter-houses, whereas the bovine stock-breeders are the most exposed population to hydatid disease with a 9% prevalence. There is no mention of similar works in Benin in medical literature.

[Treatment of bilharziasis due to Schistosoma mekongi with praziquantel]. / Traitement de la bilharziose à Schistosoma mekongi par le Praziquantel.

After a review of the mechanisms of anti-schistosomal activity of praziquantel and the treatment of Schistosoma mekongi with this drug, the authors report two cases of Schistosoma mekongi treated with praziquantel with failure. Rectal mucosa biopsies are performed and eggs are present. Light microscopic, electron microscopic and on ultra-thin sections examination of these samples don't reveal morphological alterations of Schistosoma mekongi eggs after treatment.